Lymphedema is caused by damage to the lymphatic system due to cancer treatment and is a common side effect for breast and head & neck cancers. Due to the generally considered incurable nature of lymphedema, the authors of this paper argue for multi-disciplinary strategies to reduce onset, progression and complications of lymphedema.The Abstract (de Valois et al., 2012, p. 301).

Methods and sample: An exploratory single-arm observational clinical study included breast (BC) and head and neck cancer (HNC) survivors with mild-to-moderate uncomplicated lymphoedema for ≥3 months, ≥3 months post active-cancer treatment, no active cancer disease, undergoing routine lymphoedema maintenance. Participants received seven individualised treatments (S1), and six optional additional treatments (S2). MYMOP, SF-36 and PANAS were administered at baseline, during each series, and at follow-up 4 and 12 weeks after end-of-treatment. The primary outcome was change in MYMOP scores at the end of each series.

Conclusion: This small study suggests acu/moxa is an acceptable adjunct to usual care for cancer survivors with lymphoedema. Further rigorous research is warranted to explore the effectiveness of acu/moxa in reducing the symptom burden.

de Valois et al. (2012). Assessing the Feasibility of Using Acupuncture and Moxibustion to Improve Quality of Life for Cancer Survivors with Upper Body Lymphoedema

Lymphedema is caused by damage to the lymphatic system due to cancer treatment and is a common side effect for breast and head & neck cancers. Due to the generally considered incurable nature of lymphedema, the authors of this paper argue for multi-disciplinary strategies to reduce onset, progression and complications of lymphedema.

The Bottom Line:

Cancer patients at risk of developing lymphedema want to learn how to recognize early signs and symptoms, and once diagnosed, treatment aims to reduce size, physical dysfunction and complications (de Valois et al., 2012).

de Valois et al. (2012) cites research showing that lymphedema has negative psychosocial effects for women and is “One of the most troublesome and feared consequences of breast cancer surgery” (Ganz 1999, as cited in de Valois et al., 2012, p. 302).

Acupuncture, part of Traditional Chinese Medicine, is a CAM modality cancer patients are drawn to for improvement of symptoms and better physiological and psychosocial coping (de Valois et al., 2012).

Based on previous research by one of the authors with breast cancer patients that demonstrated “…measurable improvements in wellbeing, improved quality of life, and symptom relief…” when using acupuncture de Valois et al. (2012) set out to investigate if acupuncture could be successful in the management of lymphedema asking the questions (p. 302):

Can acu/moxa improve wellbeing in cancer survivors with lymphoedema?

What symptoms are most troublesome for these individuals?

Is acupuncture a safe intervention for people with lymphoedema?

Because of the nature of lymphedema, acupuncture is considered a controversial treatment. People with lymphedema should focus on reducing the possibility of further infection and swelling via accidental or non-accidental (as in acupuncture) skin punctures in the affected area (de Valois et al. 2012). Many practitioners suggest that it is considered a good idea for lymphedema patients to avoid acupuncture altogether. However, this is not the case according to de Valois et al. (2012, p. 302) who state “In lymphoedema and cancer policy documents, acupuncture is not contraindicated, and guidance is the same as for all NASP [non-accidental skin punctures] interventions, in that needling the affected area should be avoided.”

De Valois et al. (2012) selected to use the following three validated instruments to use as outcome measures:

Medical Outcome Profile (MYMOP) “…is widely used for evaluating interventions based on holistic and participative principles, and allows patients to define and evaluate outcomes that are pertinent to them” (de Valois et al., 2012, p. 303).

de Valois et al. (2012) mention in their paper that, for further studies, they will eliminate the PANAS questionnaire due to higher than expected proportion of missing data. The authors also make a note of some limitations of their study, which are: uncontrolled study design, single setting, small number of head & neck cancer patients participants, and research acupuncturist acted as principal investigator as well (de Valois et al., 2012).

The authors also point out that they never set out to cure lymphedema, rather they wanted to show that patients with lymphedema can use acupuncture safely to address “…a range of physical and emotional conditions, and reduce symptom burden (de Valois et al., 2012, p. 307).

Because of the significant improvements (as mentioned in the abstract) further research is warranted to investigate the effects of acupuncture in lymphedema. The authors have plans for a randomized controlled trial investigating the effects of acupuncture in breast cancer related lymphedema.

What do the study results mean for a cancer patient wanting to use acupuncture addressing lymphedema?

This trial can not be generalized, due to some of the limitations mentioned above. It was simply not designed to this. It was designed as a pilot trial to determine if further research might be warranted.

That does not mean you should not discuss this option with your primary health care provider. She/he might be open to working with an expert acupuncturist to see if acupuncture could be a viable treatment, to address the physical and emotional conditions and to reduce the symptom burden you might be experiencing, especially if lymphedema is the result of breast cancer treatment.

APA: W Absenger. (2012.06.23). de Valois et al. (2012). Assessing the feasibility of using acupuncture and moxibustion to improve quality of life for cancer survivors with upper body lymphoedema [Web log post]. Retrieved from The Alternative Medicine Blog at http://amacf.org/2012/06/de-valois-et-al-2012-assessing-the-feasibility-of-using-acupuncture-and-moxibustion-to-improve-quali.htm

There is much debate whether or not antioxidant supplementation during cancer chemotherapy alters the efficacy of chemotherapy drugs. The review by Block et al. (2007), evaluating Randomized Clinical Trials (RCT), looks at RCTs that measured survival and/or treatment response levels of patients who took antioxidants while on chemotherapy in order to see if antioxidants amplify or impinge on the efficacy of the chemotherapy…Introduction

Block et al. (2007) start their review by citing no less than ten references about the use of Complementary and Alternative Medicine (CAM), showing that an estimated 13% to 87% of cancer patients use antioxidant supplements.

Antioxidants, while taken during chemotherapy are thought to

a) hinder the cytotoxicity of chemotherapy by quenching the reactive oxygen species (ROS, a.k.a. free radicals), thus rendering the drug less effective, or

The Catch-22 for a cancer patient then is to understand if antioxidant therapy can improve Quality of Life (QoL) by protecting healthy tissue or gravely interfere with the outcome of cancer.

On the other hand, antioxidants might improve clinical outcomes by helping patients tolerate an uninterrupted treatment regimen with full doses of chemotherapy (Block et al., 2007).

Methods

Patients in the studies were either on an orally or intravenously administered antioxidants and chemotherapy. Block et al. (2007) make it clear that all types of cancers were included and chemotherapies that use ROS generating mechanism, while studies using whole herbs, multi-component herbals, and synthetic antioxidants were excluded. Trials were given Jadad scores to distinguish between weak and strong study designs. A limitation pointed out by Block et al. (2007) is the fact that “…bias in preferential publication of positive trials cannot be excluded” (p. 409).

Block et al. (2007) did not find any evidence that substantiated the concern that antioxidant supplementation given while on ROS generating chemotherapy lessened the efficacy of chemotherapy in a population of advanced or relapsed patients. On the contrary, 17 of the 19 reviews established

“…statistically significant advantage or non- significantly higher survival and/or treatment response in those patients given antioxidants. Specifically, of 13 reports on survival, all showed similar or better (four being statistically significant) survival rates for the antioxidant group over the control group” (Block et al., 2007, p. 415).

Block et al. (2007) continue with their findings:

“Additionally, while one study reported similar survival results between the antioxidant arm and control overall, the largest subgroup (stage III patients taking antioxidants) was found to have a statistically significant survival advantage compared to the control group” (p. 415).

Because of the small size of studies, these studies should be construed as treatment response data, and can’t be yet generalized to a wider population. Larger trials would be needed for such a generalization.

And because statistical power calculations performed either before or after trials, one can not say of important clinical effects were missed in these smaller trials.

The Bottom Line

This paper by Block et al. (2007) hints towards evidence that antioxidant supplementation helps reduce side effects of chemotherapy such as “…neurotoxicity, thrombocytopenia, diarrhea” (p. 416) and because of that, patients who probably would have dropped out of chemotherapy were able to complete their drug regimen.

Block et al. (2007) point to research by Neugut et al. (2006) studying colon cancer patients over age 65 and the effects of the entire five to seven months of chemotherapy regimen. These patients had higher survival rates than those who only received one to four months of treatment.

Also worthwhile considering is the finding that “…among the 30% of patients who dropped out of chemotherapy treatment early, mortality rates were twice those of the group who completed therapy” (Block et al. (2007, p. 416).

In other words, whether or not to use antioxidant supplementation during chemotherapy should probably be a conversation you and your primary care provider or oncologist should have.

However, just in case you are wondering going out to your local health food store to stock up on the antioxidants mentioned in this blog entry consider the following:

Block et al. (2007) clearly make mention of antioxidants administered intravenously, right? So this should give the reader pause and consider the dosages needed to achieve the desired effects.

I am interested in articles and news releases pertaining to new research findings, preferably tied to peer-review, or descriptions of new or groundbreaking research projects, book reviews, and announcements of scientific conferences/meetings pertaining to Complementary and Alternative Medicine (CAM) or Mind-Body Medicine (MBM).

The Alternative Medicine Blog does not charge for posting announcements from universities, individual practitioners or nonprofit organizations.

If your announcement pertains to research, book reviews and conference (scientific) announcements in the categories below, I am interested in sharing it with my readers…

As mentioned in previous posts of Symptoms as Defenses, the immune system is quite a tricky thing. That is why anyone who has gone to a homeopathic practitioner knows that the homeopath asks many questions about the person’s chief complaint, minor complaints, and various other physical and psychological symptoms. Homeopaths take pride in their serious interest in and use of the idiosyncratic characteristics of each per son. The questions that homeopaths commonly ask include: Is there a time of the day that you feel best or worst or that any specific symptom occurs? How does weather affect you? How do you feel at the seashore or in the mountains? Are there any foods that you crave or to which you feel averse?

I just came back from my favorite java whole inspired by a discussion several friends of mine and I had. It was about medicine and what the medicine of the future will look like. What a great afternoon to hang out, chill and shoot the breeze about healthcare and listen to different visions of how medicine for the 21st century will take shape. Let me start by saying that the best way to understand your own culture is to visit another culture.

You can't get better without making some changes. We'll show you how li'l changes can get you to feel better and awesomer.

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About Werner Absenger

Werner is the founder of the Absenger Cancer Education Foundation (ACEF) a 501(c)(3) not for profit organization. He helps empower and improve the quality of life of West Michigan’s cancer survivors, their loved ones, caregivers, and people living with chronic disease. This goal is accomplished through research, education, and integration of evidence-based nutrition and mind-body modalities. Continue reading...

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